骨盆腔炎骨髓水肿：双能量 CT 检测。
Bone marrow edema in sacroiliitis: detection with dual-energy CT.
机构信息
Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
出版信息
Eur Radiol. 2020 Jun;30(6):3393-3400. doi: 10.1007/s00330-020-06670-7. Epub 2020 Feb 13.
OBJECTIVES
To evaluate the feasibility and diagnostic accuracy of dual-energy computed tomography (DECT) for the detection of bone marrow edema (BME) in patients suspected for sacroiliitis.
METHODS
Patients aged 18-55 years with clinical suspicion for sacroiliitis were enrolled. All patients underwent DECT and 3.0 T MRI of the sacroiliac joints on the same day. Virtual non-calcium (VNCa) images were calculated from DECT images for demonstration of BME. VNCa images were scored by two readers independently using a binary system (0 = normal bone marrow, 1 = BME). Diagnostic performance was assessed with fluid-sensitive MRI as the reference standard. ROIs were placed on VNCa images, and CT numbers were displayed. Cutoff values for BME detection were determined based on ROC curves.
RESULTS
Forty patients (16 men, 24 women, mean age 37.1 years ± 9.6 years) were included. Overall inter-reader agreement for visual image reading of BME on VNCa images was good (κ = 0.70). The sensitivity and specificity of BME detection by DECT were 65.4% and 94.2% on the quadrant level and 81.3% and 91.7% on the patient level. ROC analyses revealed AUCs of 0.90 and 0.87 for CT numbers in the ilium and sacrum, respectively. Cutoff values of - 44.4 HU (for iliac quadrants) and - 40.8 HU (for sacral quadrants) yielded sensitivities of 76.9% and 76.7% and specificities of 91.5% and 87.5%, respectively.
CONCLUSIONS
Inflammatory sacroiliac BME can be detected by VNCa images calculated from DECT, with a good interobserver agreement, moderate sensitivity, and high specificity.
KEY POINTS
• Virtual non-calcium images calculated from dual-energy CT can detect sacroiliac bone marrow edema in patients suspected for sacroiliitis. • Dual-energy CT has a high specificity in bone marrow edema detection. • Virtual non-calcium images for bone marrow edema in patients with a large amount of red bone marrow or obvious sclerosis near the articular surface should be interpreted with caution.
目的
评估双能 CT（DECT）在检测疑似骶髂关节炎患者骨髓水肿（BME）中的可行性和诊断准确性。
方法
纳入年龄在 18-55 岁之间、疑似患有骶髂关节炎的患者。所有患者均在同一天接受 DECT 和 3.0T MRI 检查。从 DECT 图像中计算出虚拟非钙（VNCa）图像，以显示 BME。两位读者使用二进制系统（0=正常骨髓，1=BME）独立对 VNCa 图像进行评分。以液体敏感 MRI 为参考标准评估诊断性能。在 VNCa 图像上放置 ROI，并显示 CT 值。根据 ROC 曲线确定 BME 检测的截断值。
结果
共纳入 40 例患者（16 名男性，24 名女性，平均年龄 37.1±9.6 岁）。VNCa 图像上 BME 的视觉图像阅读的总体观察者间一致性良好（κ=0.70）。DECT 检测 BME 的敏感性和特异性分别为象限水平的 65.4%和 94.2%，患者水平的 81.3%和 91.7%。ROC 分析显示，髂骨和骶骨 CT 值的 AUC 分别为 0.90 和 0.87。-44.4 HU（髂骨象限）和-40.8 HU（骶骨象限）的截断值分别产生 76.9%和 76.7%的敏感性和 91.5%和 87.5%的特异性。
结论
通过从 DECT 计算出的 VNCa 图像可以检测出炎症性骶髂 BME，具有良好的观察者间一致性、中等的敏感性和较高的特异性。
关键点
• 从双能 CT 计算出的虚拟非钙图像可检测疑似骶髂关节炎患者的骶髂骨髓水肿。
• 双能 CT 在骨髓水肿检测中具有很高的特异性。
• 对于关节表面附近有大量红骨髓或明显硬化的患者的虚拟非钙图像，应谨慎解释骨髓水肿。
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